Tower of Hanoi | Falling-action

Active sex life after prostate cancer

(Fictional narrative by the doctor)

James Fleck, MD, PhD & João A de Andrade, MD

Anticancerweb 10 (03), 2019

When Theophilus returned to my office for a follow up, Vilma came along.

He invited her because we would be discussing treatment-related complications that concerned both of them.

Theophilus broke the silence, saying: "The proposed treatment will reduce my sexual performance. I'm going to get a subcutaneous injection that will cause a disruption in my hormonal profile that will lead to a temporary chemical castration”.

His explanation was simple and factual but I was not sure Vilma was following it as she sat quietly.

Theophilus, on the other hand, was very talkative. He looked at me with some resentment and said, "That poses a serious problem because this treatment threatens my virility. I feel as if I no longer have my balls."

I replied saying that the testicles will still be there. The advantage of a chemical orchiectomy is that it is usually reversible. At the end of androgen deprivation therapy (ADT), there would be a reasonable chance of regaining sexual function. Testosterone levels would increase again but libido and sexual performance would largely depend on his general health.

Theophilus felt that this was an opportune moment to start an open discussion. Looking at me and his wife he said: “My wife and I, despite being together for fifty years, still have an active sex life. It is not as frequent as when we were young, but the flame is still there. I do not feel good about the possibility of becoming impotent and I feel bad to subject Vilma to this. "

Suddenly, Theophilus fixed his eyes on Vilma, as if asking for her opinion.

Vilma made her one and only comment: "Our life has been wonderful. We always had a healthy, affectionate and harmonious relationship. My love for Theophilus is unconditional. When we got married we knew it would be forever. This was the most important of our wedding vows. Theophilus always knew that and now it seems that he needs confirmation of our commitment. He should understand that sex is the result of mutual affection and that everything we do together is sexual. All the care and consideration he gives me in our daily lives is sexual. This is something men slowly understand, but we women are born knowing and seeking. The concept of sex transcends the act. That is all I have to say!"

As soon as he heard this, Theophilus behavior changed drastically! With an expression of gratitude and tearful eyes he looked at me and said, almost in a whisper and with a choked voice: "Let the treatment begin."

I was fortunate to witness such a mature and affectionate couple. Both expressed love, respect and commitment. I learned a lot from them and there was nothing else to be said. Vilma had eloquently summed up the main issue at hand!

We finished the consultation.

Theophilus followed every step of the treatment at a dose intensity of 100%, which means that he received the full prescribed dose of EBRT and ADT at the right time, which usually leads to better results.

During the treatment, he experienced various forms of acute toxicity, especially in the final weeks of EBRT. The skin of the perineum had some peeling, and became very sensitive and painful. He had inflammation of the bladder and rectum, which led to some discomfort associated with urination and bowel movements. He complained of abdominal pain and felt very weak at times. However, he persisted and had perfect adherence to all treatments.

About five weeks after the end of the EBRT, he was virtually asymptomatic. The PSA level evaluated six months after radiotherapy was very low at 0.01 ng / mL, confirming the expected good results of the combined treatment.

Five years later, Theophilus remains in complete remission. The androgen deprivation treatment is over and he continues to look younger and very healthy. He follows the doctor's recommendations, manages to keep a healthy weight and exercises regularly. 

Vilma is also very healthy.

The couple was happy to report that they have resumed their active sex life! I did not ask for details but was very happy for them….

Theophilus continues to propose mathematical challenges.

He recently introduced me to Fibonacci numbers.  Those are a sequence of numbers recursively defined by a formula, which allows to anticipate the distribution of the branches of a tree.

Meanwhile, I keep trying to explain to him how doctors think, but sometimes we still disagree!

During his last appointment, I confessed that I gave up the Tower of Hanoi, since I could not pass the five-disk challenge.

Theophilus looked at me with a mocking expression and said: "My dear doctor, to solve these questions you need to be born as a friend of God."

To be continued in PLOT 6 (resolution): Learning from diversity…

*       Attention: The story 2 will be published sequentially from the PLOT 1 to the PLOT 6, however it will appear backwards. So, you will always see the most recent publication. Just browse in numbered pages located at the bottom of the homepage and start to read the story 2 from the beginning.  

© Copyright 2019 Anticancerweb

 James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil 2019

Joao A. de Andrade, MD: Professor of Medicine and Chief Medical Officer, Vanderbilt Lung Institute, Vanderbilt University Medical Center, Nashville, TN – USA 2019 (Associate Editor)